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Behavioral Ecological Model


The San Diego Department of Health and Human Services with the Center for Behavioral Epidemiology and Community Health (CBEACH), School of Public Health, SDSU will evaluate a new HIV prevention program. "Health Link" consists of case management where a professional social worker, health educator and nurse practitioner provide 8 integrated counseling sessions to high-risk adults participating in the California, Office of AIDS-funded HIV Counseling and Testing program. Health Link includes outside referrals for psychosocial or medical service needs. In session 1, the client and the health educator develop a one-on-one, client-centered, short-term risk reduction plan. At the second visit, a LCSW examines psychosocial bases for ongoing risk behaviors, the short-term risk reduction plan is enhanced, and the initiation of a long-term risk reduction strategy is formulated. In the third visit, the nurse practitioner provides medical screening, including STD, HBV, and HCV screening, with HBV vaccination, if warranted. Sessions 4 &endash; 7 are devoted to problem solving, skills training, practice in correct condom use techniques, and shaping individual risk reduction practices, with brief psychosocial and medical follow-ups. Clients are provided with free condoms. The aims are to determine whether the program increases condom use, decreases sexual and drug-use risk practices and lowers HIV/STD incidence rates. 400 male and female adults, including MSMs and IDUs, who have tested HIV-negative at least twice, will be recruited from African American, Latino and Caucasian subgroups. Volunteers will be assigned at random to a Minimal Counseling Control (N = 200) condition or to Health Link (N = 200). Staff unfamiliar with counseling will assess risk practices and condom use prior to initiation of counseling, at 2 months (post-counseling), 5 months post-baseline (3 months post- counseling) and 8 months post-baseline (6 months post-counseling). Assessments will include STD testing at each measurement point; HIV testing will be repeated only at the final follow-up measure (8 months). Assessment also will include attendance, quality of counseling delivered and other process/quality control measures. This provides a 2 (condition) X 4 (repeated measures/time) experimental design. Changes in risk practices, condom use and STD infections will be computed as primary and secondary outcomes. Primary efficacy tests will be limited to contrasts between those assigned to the Health Link program v the Minimal Intervention Control, without regard to risk category or race/ethnicity. Exploratory analyses will be conducted by including attendance and other possible confounding variables, race/ethnicity and AIDS risk categories in multivariate models of change over time. County staff will obtain evaluation training and CBEACH will assist the County in developing dissemination plans. Results will inform more comprehensive evaluations and program refinement for AIDS prevention among very high-risk adults.

Principal Investigator: Mel Hovell, PhD, MPH

Project Coordinator: Carol Sipan, MPH

Funded 1998-2000

Source: Universitywide AIDS Research Program


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